PCT after using Clomid during TRT

[DMAIC]

First post here, so I'll summarize my post in a few sentences for those that only have time for the highlights. I am looking for a PCT program with Clomid and Letro. I have 50 tabs of 50mg Clomid left and about the same of Letro at 2.5mg each. I am guessing that I should start a standard Clomid with AI protocol for 4 or so weeks. However how my scenario is different from most is I have been taking Clomid during my TRT, so I'm wondering if anyone has experience with running a PCT after that scenario, or can advise if I should do anything differently. That's the cliff notes, if you want more details regarding how long I was on Clomid monotherapy and when I started taking extraneous testosterone shots, my story is below. Thanks for any help anyone can provide.

I first went to a TRT doc in June 2017 after struggling with the usual Low-T symptoms. I was hesitant to get on TRT because I wasn't sure Low-T was the root cause of my problems so I tried Clomid monotherapy (50mg/daily) from July 2017 thru October 2017 (approx 3 mo). Here are my baseline #'s before starting the Clomid:

Total T: 424
Free T: 7.37
FSH: 3.1
LH: 2.3

I got my blood drawn monthly while on Clomid monotherapy for the next 4 months. My first set of labs indicated that I was responding well to the treatment after a month on paper, my LH and FSH along with Total and Free Test improved dramatically, however my E2 was still sky high and I didn't feel really that much better. Over the next several months ended up trying different dosages of the Clomid and different AI's, starting with Arimidex then switching to Letrozole.

Nothing brought my estrogen levels down over the four months, they bounced between 70-80. From research it appears this is because the estrogen was being created inside my testicles from the Clomid stimulation vs. from extraneous testosterone administration. So in November 2017 I started taking 400mg/week of test, but my Dr. told me to stay on the Clomid (at a dose of 25mg/daily) instead of taking hGC, and continue with the Letro at 2.5mg daily.

So for the last 3 months up until this week, that has been my protocol. I can't say with any conviction that my symptoms greatly improved, even with the below test results as of this past month:

Total T: >1200
Free T: >50
FSH: 19.2
LH: 18.8

With those numbers in theory I should be trying to bang every hot girl I see, among other things. The only real difference I can feel is with my muscular development and a somewhat better mood with less depressing thoughts. After reviewing last months results with my Dr., he suggested that if I really wasn't seeing a large improvement in symptoms, and I didn't want to stay on TRT, then I should try hCG monotherapy. I declined as I feel exhausted with all the appointments, researching forums, blood draws, pins, etc. I figured that if I go off everything and feel the same, then I know without a doubt my low T like symptoms are from something else.

I told him I just wanted to cease all treatment, but wanted to know if I should continue with my Clomid and AI on a taper PCT. He said that was not necessary, so I am back on the forums and this time posting in the hopes of getting some help, because I cannot find info on a PCT to use when one has taken Clomid daily during their TRT. Thank you for any input you can provide with my situation.

P.S. I am posting on several forums but just one reply to my post on any of them would be great.

[kelkel]

Before deciding on clomid were other blood work indicators examined? Such as thyroid, cortisol, prolactin, etc?
Do you know your shbg level pre-clomid?
What is your age, height, weight?
The estrogen tests that were all high, were they standard estradiol or a sensitive E2 assay?
Why would a doctor agree to 400 mgs test? That's a cycle dosage.

Clomid works for some, not for others. If you're older I'd always recommend against it. Only real logic in using it imho would be to maintain fertility if younger and interested in procreation.

I'm a little confused with your last LH/FSH readings. Normally when on exogenous testosterone clomid won't ramp these levels up at all. You advised you were only off test for one week prior to this blood work. Is that accurate or could it have been longer?

[DMAIC]

Before deciding on clomid were other blood work indicators examined? Such as thyroid, cortisol, prolactin, etc?

Unfortunately several panels/tests were missed on my baseline labs (Dr. blamed it on the MA) and the Thyroid panel was one that was missed. I did try NatureThroid but it didn't seem to help symptoms. These are definitely 3 areas I will shift my focus on once fully transitioning off TRT/PCT program.

Do you know your shbg level pre-clomid?

SHBG wasn't included in my baseline labs either. On my first set of labs after taking Clomid for a month, the level came back at 30.2. I do plan on having this included in future labs after my PCT from TRT.

What is your age, height, weight?

40, 6'1", and 220 lbs

The estrogen tests that were all high, were they standard estradiol or a sensitive E2 assay?

The labs just say "estradiol".

Why would a doctor agree to 400 mgs test? That's a cycle dosage.

It was actually his suggestion. He said he wants to see if my symptoms improve quickly with an above average does. I have learned since, that there can be a point of diminishing returns and adding more test doesn't always help with symptom management.

Clomid works for some, not for others. If you're older I'd always recommend against it. Only real logic in using it imho would be to maintain fertility if younger and interested in procreation.

Since I was on the fence about kids in my future, and because I was hesitant to commit to lifelong TRT through shots, we gave Clomid on it's own a shot. My test level rose to 850 on Clomid only, but my Estrogen couldn't fall below 70-80 range and I didn't really feel like my symptoms had improved.

I'm a little confused with your last LH/FSH readings. Normally when on exogenous testosterone clomid won't ramp these levels up at all. You advised you were only off test for one week prior to this blood work. Is that accurate or could it have been longer?

Actually I hadn't been off during those labs which were taken last month. I stopped test administration on Friday of this past week. I know and that is what is really confusing me. From everything I read, people are saying that you will still be shut down by taking Clomid with test, because the test is supposed to "wipe out" any signal to produce test from Clomid administration, but I have not been able to see any labs that back up this line of thinking, and my experience certainly looks to show the opposite, right?

Given that, I'm starting to think maybe I should just keep taking the Clomid and AI, tapering down from my current dosage of 25mg daily (I haven't taken any more test this week but I am still taking the Clomid and Letro). I only have a limited supply though (50 tabs of 50mg) and unsure if my Dr. will prescribe me more to transition off as part of an extended PCT (if needed).

Thanks so much for replying and I look forward to this continued discussion.

[kelkel]

The problem with standard estradiol is that it's geared to women. It's not sensitive enough to be accurate in men and therefore tends to read much higher than it should. This then causes physicians (who don't understand this) to prescribe AI's which very well may not be necessary and result in more issues. It needs to be a Sensitive E2 Assay.

BTW, there are sites where you can pull your own blood work rather cheaply and without a doctors script. Check out:

www.discountedlabs.com

www.privatemdlabs.com

Definitly don't agree with a 400 mgs dose. Not sure what other type of medication he would over-prescribe in such a manner. Some docs will front load one week of a larger dose but that's about it. Like you referenced, to much just causes a domino effect of symptoms to be mitigated. Not worth it.

Your mentioning of not feeling better with clomid is quite common. Naturally it's subjective but the opinion you expressed is quite common with guys. Realize that you can maintain fertility on testosterone by using HCG. Read this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378070/

Re clomid and elevated reading while on test. It just strikes me as odd. I've run BW before myself with added nolvadex while on TRT and LH/FSH results were not impacted at all. Not sure why yours would show as so elevated when in the presence of 400 mgs testosterone. Clomid works by making the hypothalamus think there's no estrogen so it then ramps up production. I wonder if the letro you're taking has your E2 so low that even with 400 T the clomid is having a stimulatory effect? Just a thought but letro is hard to dose and is a suicidal AI. Also your prior estrogen tests could be wildly inaccurate as mentioned. Love to figure this out.

[DMAIC]

Awesome info and resources. Thank you very much kelkel. How would you suggest I handle my PCT now with the remaining Clomid and Letro that I have (about 50 tabs of each, 50mg and 2.5mg respectively) to transition off. Would 4-6 weeks be about right since I have been on the Clomid during TRT administration? I was thinking maybe staying at 25/day for the four weeks while the exogenous test clear out of my system and then drop to 25mg EOD for another two weeks? Does that seem too long or too short? I'd rather not continue the Clomid for longer than I have to but also don't want to stop quickly and fall off a cliff.

[kelkel]

I think your pct plan is sound and I'd do just that. Five weeks may be sufficient. Particularly based on your already hyperstimulated pituitary levels I would not think elevated levels of clomid (as in more mg's) would be needed. Still baffled by those LH levels btw.

Remember though, odds are you're going to just go back to your levels you were at pre-TRT. Then what's the plan? Please post up on this thread how this goes please. It may help other guys out. It's also nice to see someone doing their research and self-educating.

kel

[DMAIC]

Thanks man, I will definitely come back and update along my journey, appreciate your help.